ch 29: communication & physical assessment Flashcards
EXAM 1 content
before even starting the interview, what should you do?
establish a setting
- introduction
- assure privacy & confidentiality
how should you communicate with families?
- encourage them to talk to their kid & what they want
- direct focus
- listen & cultural awareness
- using silence
- empathy
- guidance
- avoid blocks of communication
- use an interpreter if needed
- talk about the different developmental processes
what should you as the nurse control about yourself?
know your weaknesses
- control your face
- dont be overwhelming
- self awareness
what are some communication techniques?
- verbal & non verbal
- play
how should you take history?
- identify info
- know the chief complaint
- if there is a present illness –> OLD CARTS
what should you jot down when taking past medical history for the child?
- birth hx
- any previous illness, injuries & operations
- allergies
- current medications
- immunizations
- diet hx
- habits
- growth & development!!
how should you approach the interview? what is important before asking questions?
- explain what you are doing
- let them get comfortable
- ask open ended questions
how do you make an infant comfortable for the interview?
ask questions to the parents first, let the infant get used to their environment
how do you let a preschooler get comfortable before the interview?
play with them first
how do you let an adolescent get comfortable?
talk to them right away
what is the process of the interview (in steps)?
- introduce yourself
- get to know them
- explain what you are doing
- ask about what they are here for (if pain –> OLD CARTS)
- neuro
- cardiovascular
- respiratory
- GI
- GU
- musculoskeletal
- skin
- sexual history & more private questions
after assessing the skin in the interview, how old should the patient be to know if you want to ask about sexual history?
13 years old
what should you do before asking about more personal questions and their sexual history?
ask the parents to step out of the room
what are the interviewing steps for sexual history & more private questions?
- ask the parent to step out
- explain that the information is confidential except for suicide & homicide
- aks about depression, anxiety & suicide
- ask about intercourse
- sexual orientation
- ask if they have a trusted adult they can go to
- education
what should you jot down for family health history?
- geographic location: can understand different diseases based on loco
- family structure
what should you assess for nutrition in the child?
- diet intake
- hair, skin, mouth, & eyes
what are the results/evaluation choices after assessing the nutrition of the child?
- malnourished
- at risk
- well nourished
- overweight or obese
what are some challenges to examining a child?
they can be reluctant & have trantrums
how should we approach examining of the child?
most comfortable first –> least comfortable last
what is the most uncomfortable to children?
eyes, ears & mouth
what are the goals to a pediatric assessment?
- minimize stress & anxiety
- foster trust
- maximum preparation
- preserve security of parent & child
- maximize accuracy
what are the assessment goals of an infant?
make these a priority when they are calm
- RR
- HR
- bowel sounds
how should we prepare a child for an assessment?
- cooperation enhanced with parents
- age appropriate techniques
- positioning
what are some age appropriate techniques?
- dolls & teddy bears
- parents present
- videos
- demonstration
what is prioritized in a physical exam?
growth measurements
- length
- height
- weight
circumference measures
- skin thickness
- arm circumference
- head circumference
how should we approach the physical exam in school age kids?
make it like a game – they want to see how strong they are
how do growth curves track development of a child?
the body grows during homeostasis
- if child is dropping off –> a sign that something is wrong
- endocrine or medical problems
what should we jot down for physiological measurements and what goes first?
respiratory is always first then
- temperature
- pulse: radial, brachial, or apical
what area is prefered to get a pulse on a child?
apical
how long should you count for RR & HR and why?
60 seconds – to get a full accurate count
where are areas can you put the BP cuff?
- brachial artery
- radial artery
- popliteal artery
- dorsalis pedis artery
- posterior tibial artery
when do posterior cranial sutures close for infants?
2 months
when do anterior cranial sutures close for infants?
12-18 months
do we always assess the cranial nerves?
no, only for specific neuro exams
what is the eye chart called for younger kids?
allen figures chart
why aren’t we really worried ab an infant’s vision?
- can only see mom’s face – they should be able to follow mom’s face with their eyes
- vision is still developing
when assessing the internal structures of the ear, what age do we pull the pinna down and back?
less than 2 years old
when assessing the internal structures of the ear, what age do we pull the pinna up and back?
2 yo and older
what should we assess about the nose?
- sides
- nares
- patency
- any drainage
- how does it fit with the rest of their face?
what should we be aware about the chest?
one side can be lower then the other
what is something we need to get used to when auscultating the lungs?
hearing the heart & lungs simultaneously
Should we worry about heart murmurs when we heart them in kids?
not really, some kids grow out of it
how should we auscultate the heart?
APE To Man
what should we look out for when assessing genitalia?
swelling
what should we look out for when assessing the anus?
- patency
- are they pooping?
describe genu valgum
when the kids knees are stuck together like gum
describe genu varum
when the knees are spread apart like a bottle of rum is between them
which is more normal, genu valgum or genu varum?
genu varum, “bow leg”
when is genu valgum and genu varum considered a problem?
when their legs are still like that by the age of 2yo +
